子宫动脉栓塞联合甲氨蝶呤治疗剖宫产瘢痕妊娠的临床研究

Clinical study of uterine artery embolization combined with methotrexate in the treatment of cesarean scar pregnancy

目的探讨子宫动脉栓塞(UAE)联合甲氨蝶呤(MTX)灌注能否提高子宫动脉栓塞术作为剖宫产瘢痕妊娠(CSP)术前预处理的治疗效果。方法分析2008年1月至2021年5月在中南大学湘雅三医院治疗的310例剖宫产瘢痕妊娠患者临床资料,病例组预处理方式为子宫动脉栓塞联合子宫动脉甲氨蝶呤灌注(n=159例),对照组预处理方式为单纯子宫动脉栓塞术(n=151例),所有患者进行预处理后均采用清宫术治疗,比较两组的临床基本特征和治疗效果。结果病例组与对照组的临床基本特征资料以及治疗效果比较差异均无统计学意义(P>0.05);但病例组的不良反应率更高(37.7%vs.26.5%)、住院时间更长[12(8,15)d vs.9(6,11)d]、住院费用更高[13624(12386,15824)元vs.13596(10872,15207)元],差异均有统计学意义(P<0.05)。结论UAE联合甲氨蝶呤灌注不能提高子宫动脉栓塞术作为剖宫产瘢痕妊娠术前预处理的治疗效果,且子宫动脉栓塞联合甲氨蝶呤灌注可能会增加剖宫产瘢痕妊娠患者的不良反应发生率、住院时间和住院费用。UAE不应常规联合子宫动脉MTX灌注治疗CSP患者。

Objective To investigate whether addition of intra-arterial MTX infusion improves the treatment effect of uterine artery embolization(UAE)as pretreatment before surgery for cesarean scar pregnancy(CSP).Methods Clinical data of CSP patients admitted from January 2008 to May 2021 in the Third Xiangya Hospital of Central South University were analyzed.A total of 310 CSP patients were included,with 151 patients receiving UAE followed by curettage and159 patients receiving intra-arterial MTX infusion followed by UAE and curettage.Results The baseline characteristics and treatment effects were not significantly different between the two groups(P>0.05).However,the incidence of side effects(37.7%vs.26.5%,P<0.05),the hospitalization length[12(8,15)d vs.9(6,11)d,P<0.05]and hospitalization costs[13624(12386,15824)yuan vs.13596(10872,15207)yuan,P<0.05]were significantly increased by addition of intra-arterial MTX infusion(P<0.05).Conclusions Adding intra-arterial MTX to UAE and curettage doesn’t exert additional benefit on the basis of UAE and curettage treatment.